Designing for double jaw surgery

Sorry, thanks very much. Yep, we start now. Thank you. So, frontal view, x-factor, I guess. The right side, left side, bottom view. Just zoom in on the bone, at the base of the palate. Without the mandible, or? I don't know if you've got the center line. That's good, frontal view, I guess. Yep, now the line with the upper dental midline, AMS, nasal. Yeah, I know you've got it with it, but I want it right in between the eyebrow. Okay, not sure if I'm at tissue level. Yeah, I'm not convinced you're right between the eyebrows. You're only a quarter of a mile off. Just bring it to her right. Much more to her right side. Like this, or even more? No, no. Yeah, just don't take the face away. Just look at it from underneath. Just zoom in on the bone. Yep, now you've got it. Bottom. Yeah, now you've got it. Look at it from the front. Okay. Just put the grip in. The grip? Okay, you've got it. Okay, thank you. Okay, perfect. Zooming in on the full one, if I prepare to zoom in a bit. So this is from a straight frontal view. I'll hide the bone for a moment. There's no need for angulation upwards. Can you bring it up a little bit higher? Yep. Just laterally on both sides? More at the posterior. Oh, really? Yeah. Alright, then. I need to make it nice. I want to try to get as much of the buttress as I can. And at the piriform level, is that a good height as what we currently have? Yeah, the piriform's alright. It's just the lateral buttress, I think. You can sort of bring it up a little bit higher. Okay. That'll give me a little bit more cheek support. And then going higher up as well? Yeah, just higher up at the back. Yeah, about there. That look better? And then similar to the patient's left side? Yes, please. Okay, now at the piriform. Slightly higher at the buttress, and then going up. Let's bring it in on her right, at the back. So a bit more angulation. Yeah, yeah. Even a bit more, like over here, inwards? Yeah, yeah. Bring it in, bring it in at the back. Yeah, just there, at that point. I don't know if I can twist it or rotate it. Yeah, just need to rotate it a bit like this. And then, yeah, just a bunch again. Yeah, just a little bit down at the piriform. Yeah, so the side line looks from below. Yeah, I know. Yeah, that's right. You should go down through everything. Can you ask when, just before he intubates you, just to go down the right nostril? Uh, to... He's the anesthetist. Yeah, to do what, sorry? When he puts a tube down your nose, can you ask him to use the right nostril? Okay. It's the harder nostril. Yeah, I just want him to. It's the side that we need to, I need to shift it to the left. And so I'm trying to get the use of the tube. Could you put a notation below it, right at the beginning of the report, to intubate right nostril? Yep, sure. Because my septum is fully, like, it's almost all blocked to the right. I know, that's why I want to use the tube to help me. Ah, I see, I see, okay. So the whole septum's deviated to your right. Yes. So I can actually physically use the tube to shift it. And then when I replace it, it goes in the same direction. Okay. We'll work at it. Alright. Yes, there we are. Okay, so this is how that looks. For the split, I prepared there, between the central, as you can see, and in between the apex of the two sides. Does that look okay for you? From the bottom view, you can see, running through the PMS as well. Right, okay, good. I also prepared the piriform osteotomy. I'll show them now. So yeah, I followed the lowest one, like, patient's right side. Yeah, so what I need is a spy go, like, where they cross over in the middle. Just both osteotomy planes, just lift them up. Ah, okay. So both osteotomy's up, alright. Just like, translating upwards? Yeah. Okay, so I'll first right side, let me know if it's okay. Yep, that's it. Okay, I'll do the left side with the facial midline. I'll just completely cross it at the facial midline, like this. Thank you. Alright, does that look okay for you, for the piriform? Yes, please. Yep. Okay, moving on to the PSSO. As you can see, I have the vertical osteotomy now, mid 7. Does that look okay? Any thoughts there? I'm just looking, just looking. Yeah, sure. Yeah, show me, yeah, yeah. Okay, regarding the genial poly, then, I just, yeah, prepared something like this. Not sure if it's, like, too wide. Show me the right. Yeah, maybe, perhaps. As you can see, yeah, at the right K now, we're here. Yeah, I think, yeah, I think you've got to lift at the hour right corner. Okay, like this? A bit more even? No, I don't think that's it. Okay, thank you. And flare out the base. On both sides? No, just the left. Hour right side, or? Hour right. Yeah, like this? That's it, yep. Just give me back the mandible. That'll be a bit. Symmetrical to the chin now. Look at it from underneath. Bring in, bring in hour left base corner. Like this? Or a bit more? And her left base. Her left base. Like this? Or a bit more? I don't see it. I don't see anything. It's weird. I'm sorry. Left base. Her left base. Her left base, always. Yep. Corner, yep. In, in, in. Yep. I'm moving it in. Not sure if the screen is frozen. It's lagging a bit. Yeah, keep going, keep going. Okay, yep. And just rotate the top, hour top right corner. Hour top right. Like this? Yep, yep. Okay. Look at it from the front. Yep, okay, good. Thank you. No, you need to double check that from the bottom view. Oh, sorry. Oh, have we got it? Yeah. No, we haven't got it. No, okay. No, you have to go up a bit. Yeah. Angle it. Oh, yeah. Trying to grab the muscles behind your tongue so you don't snore. Yep. And, yeah, go more, go more. Just, I think you have to really scoop it up and then get, yeah, keep going, keep going, keep going, keep going, keep going. Stop. And now have a look at the back. Yep. And now just drop it that one mil. Oh, yeah. Extend the flares. Yeah, just bodily down a mil. Yep. As you can, you can see the depressions in the muscles there. So we're well above it. Like this. A bit more. A bit more, a bit more, a bit more. Now just check the T. Yep. It's very clear. Drop it. All drop it one mil. Okay. Yep. Just look at it from behind again. Okay. Do the same rotation. Okay. Let's do some additional rotation. Yeah, no, we've got the muscles. It's okay. Yep. Just extend the wings. Yep. And just check the apices of the teeth here. Yeah, by doing that rotation again, quite close. Half a mil down. Okay. So does that look okay? Yep. And then I'll show you the splitter, as you can see. It's been angulated to just have an equal space. Let's see. Happy with that? Yes, please. Yep. Who's doing the Invisalign? Do you need to look? Right here. How long have you been doing Invisalign? Oh, about March this year, I think it was. Yeah. Sorry, you were going to ask me? Sorry? You were going to ask me something? No. I saved the file in the meantime, so good to go. Do you want me to link the mandible parts to the maxilla? Or, let's be... Let's put a midline? Not yet, so I'll do that first. Let's put 0.4 mils to her right side. From the right, beside the calvarium, please. Yep. Put a rotational mesial of the red, not in the true frontal view. And rotate axially positive 3 degrees. 1, 2, 3. Yep. Oh, just like positive, like clockwise 3 degrees? Clockwise, yeah. This is 3 degrees. And coronally negative 1, 2. 1, 2. Look at it from the right. Sagittally positive 1, 2. 1, 2. And translate it backward 1 mil. Okay. Look at it from underneath and check your distance. Okay. Put mesial rotation on the red again. Rotate it counterclockwise 1 degree. Yep. Axially right. Axially. Yep. 1 degree. From memory, quite complicated. And move the left maxilla to our right half a mil. Um, so patient's left maxilla. Patient's left radial to radial. Half a mil. Check your distances. To Mars as well? Yep. Put the rotation on the orange again. At the mesial? Rotate, yeah, the mesial. Rotate it in 1 degree. Look at it from the right. Lift it up at the back to the head. How much? 1 degree. Shift it backwards half a mil. Look at it from the front. Check your distances. Okay. Shift everything to the left exactly 0.4 of a mil. 0.4. Patient's left side right. Yes. Yep. Check your distances. Do the first. Yep. Put the rotation point on the distal of the blue premolar. Second premolar. Uh, distal, so over here. Distal part. Distal of the second premolar. No, that's the palatal. There. Uh, so yeah. This rotate, clockwise rotate actually the distal, not the middle, the distal. So like the palatal, palatal part over here? No. The, the. Like the distal aspect of like the, the. Of the second premolar of the blue. That's a palatal. That's a midpoint. That's there. That's it? Yeah. The distal, yeah. Okay. Now clockwise rotate that a quarter of a degree. Okay. Alright. Okay. Alright. Now look at it from the front. Look towards the midline exactly point two. And the, and the orange to the midline exactly point. So I did the left side already. One last check of measurements. Sorry. Yep. Uh, actually, sorry, before you do that, just look at it from the right. Look from the right. Check your measurements. Did you do it first and the second one? Yeah. Just the first one. Yeah. Okay. Good. Alright. Thank you. Alright. Just show me the calvarium. Mm-hmm. How much have I advanced to the right? Excellent. Okay. Right side view. So on the right side. Measure that. Yeah. One millimeter. Okay. And the left doesn't move at all. Okay. Oh, it's moved a little bit. Alright. That's central. Okay. Now put the rotation point. So we're doing it counterclockwise. Can you put the rotation point on the piriform? Mm-hmm. So now I keep both sides together, right? Yeah. Uh, at the osteotomy level? Mm-hmm. Over here. Is that a good point? I don't know. Here. And now counterclockwise rotate. Mm-hmm. And now counterclockwise rotate that. One, two, three. Yep. One. Actually, uh, no. Go back. One, two, three. Go back. Yep. Okay. Um, can you put a transparency of the phone? Uh, yep. Can you put the rotation point on the central? Sure. Yeah. I'm going to do that without the transparency. That's okay. Yep. Use this up. Good. Um, so just at the incisal level, right? Mm-hmm. Uh, one degree incline. Counterclockwise. Yep. Yeah, yes, please. One, two, three, four, four. Yep. That's five now. Okay. Five, six, seven, eight. The piriform is mating. Like at the F7? Yep. I'll go by steps of a mil. So this is one, two, three, three. Okay. Let's look at it from the other side. From the left. Let's rise the whole thing one mil. I'll put a mil. Oh, complex. And bounce it one mil. Four mil overall. Okay. Yep. Another mil. Put it from the right. It's a strict right side. All right. Another mil. Yep. Another mil forward. All right. I'll show the strict right side again. Additional mil. Okay. Show us some angle now. Show us the angle more. All right. Do you want me to make any measurements? No, no. It's all right. Okay. All right. Bounce that. Yep. I'll take the chin as well. Just a whole complex forward. All right. Yes, please. So just, yeah, just straight advancements. Seven mil already. Get down. Get down with two. Let's look at it from the front at this shifted middle. I'm just going to hide. Put completely aligned. Make sure I'm aligned. I'm just going to put the rotation point right in the middle. Keeping the whole complex there. Yep. And drop it down at the back. This is done with one degree. A bit more. Yep. This is three degrees. Okay. So from the left side. Just zoom in on the yellow. And I want you to be actually rotating it inward. So I want to get that molar in. Yep. So now I'll just. It's only the yellow right. It's only the rest. Yep. No, no. Not the rest. The rest. All right. Yeah. No, no, not. No, no. The whole thing. Not the whole thing. Okay. Yeah. Rotate it. Rotate the molar in with the point of rotation at the incisors. Make sure the. Is that a good view like this? Yeah. A bit more. Okay. I'll do the rest rotation. Ah sorry. This is half a degree. This is one degree. Had more. Yep. This is half a degree more. All right. the green for a rotation point on the mesial. I'll leave the chin as well for now, just on the degree. Okay from the front now. This is half a degree, 1 degree, 2 degrees, I'll go back 1 degree increments. This is 3 degrees, 4 degrees, 5 degrees. Drop it at the back. 1, 2, 3, this is 3 degrees. Up, up, don't go up 1 degree. Up 1, yep, just up at 1 again. Yep, move it from the front. Okay, okay, just show me right into the incisor. I want you to get that as close as you can. Yep, so just moving both sides a bit forwards. No, no, not green. The tooth is back. Go forward as close as you can. With the green or? Yeah, with the, just with the green. Only with the green, yep. I'll go by steps of 0.1 millimetre, 0.2. I think we're now touching. You're touching. I'll check in the slices. Okay, just check, check the bite. Yep. In the slices or? No, no, just in the 3D. This one I see. Yep. First to the right sides. Alright, okay, I've got a bit of wiggle room. Okay, just zoom in obliquely into the formation. On the right side here. Okay, put the rotation point on the mesial of the green. Actually, no, put it on the distal of the second, of the lateral, distal of the lateral. Over here? Yeah, yep. Clockwise rotate that, the axiom. This is 1 degree, 3 degrees. Stop, stop, stop, stop. Now slide it to the right about 0.2 of a millimetre. So both of the outwards, right? 1.3, sorry, 0.2, is that correct? This is outwards. Okay, 0.3. An additional 0.1 and look at it from the right. Stretch the right side or the gusps? Yeah, yeah, yeah, no, it's good. Okay, just bear with me. Put the rotation point on the tip of the green again, the mesial of the green. Just drop the back down a bit. I'll do half a degree maybe like this. Now slide it forward. Just check the incisor, the edge. I've got a bit of, do I get any room? Yep, it's in there, a bit of space to bring it slightly forward. Yeah, just bring it forward. This is 0.1, 0.2, 0.3 or? Yeah, yeah, yeah, no, that's it. Okay, I've got a bit more room. And I'm dead on midline with those midlines, that dental midline. Facial midline. Put it on the facial midline. So you can see the upper dental midline is touched off, the lower one is not here. Yeah, the dental midline's off, but everything else is symmetrical. So it's just invisalign to fix that. But it's the dental midline on center. Oh, it makes it up. It is, yeah. Okay, look at that. That's pretty level though, isn't it? Yep. Can I get any more wiggle? Okay, just zoom in again. On the right side or? Yeah, just canine to canine. I just want to. Oh, yeah. I'm pretty, I'm getting there, aren't I? Look at that. Okay, all right. Okay, just check your content every day. Good, isn't it? Okay. I'll start with the right side. That's okay. Just give me a view on the right. That's a good advantage. Okay. I'll start with some groin outwards. Is that a good point of attention? Yes, please. Yep. One, two, three, four, five, six, seven. Yep. No, sorry, this is seven. All right, seven. And just rotate it in. Yep. One, two, three, four, five, six, seven, eight. Top over here. One, two, three, four, five. I've got a lag. Okay, sorry. I'll wait at five. Rotate it in. One, two. That's it. Sorry. Okay, I'll start two. Let's check your distances. I put the rotation point again on the right condyle. Yeah, patient's right condyle. Rotate it out. One, two. One, two. That's it. And in. One, two, three. Okay. No, not three. Okay, this is two again. Okay, just bear with me for a sec. Just thinking. Translate green to the right 0.25. To patient's right side, right? Yep. Yep. That's 0.25. Zoom in on the incisor, on the underside, so you can see what kind of contact you've got. Yeah, I'll wait for me on the view. Like this, or? Okay, yeah, yeah, yeah, okay. Just bear with me for a sec. Put the rotation point on the tip of the first premolar. On green? On green. Over here, on the point? Yeah, yeah, yeah. And axially rotate that inward quarter of a degree. Counterclockwise, right? No, clockwise. Ah, clockwise. Inwards, the incisors, inwards. Like this. Yeah. This is quarter of a degree clockwise. Okay, how close are the incisors there? So we're not interfering here. It's quite close. This is interfering? No, no interference here. Go, go, go, go. Just go on that same rotation. Just go another quarter of a degree. Inwards, yep. This is one quarter of a degree more inwards at the incisors. Is it touching now? So what I did is like clockwise rotation. So that incisor of the green would go a bit more back, right? No, no. It shouldn't go back. It should be touching the yellow. Ah, you mean touching the yellow. Okay, okay. I thought touching the upper central incisor. No, no, no, no. Ah, no. No, it's not touching. It's not touching. I want it to, no. I just want it to rotate it so it just touches. Okay, so just feed another quarter of a degree. Yeah, a bit more, a bit more. Okay, stop. Yeah. Okay, now put the red back. Now advance the green, right? Yeah, advance it with just steps of a 0.1, 0.6, 0.1, 0.2, 0.3. I think it's touching. Touching? Ah, yeah. Let's see over here. Yeah. Ah, yeah, yeah. All right, okay. All right. Yep, okay. Just check the molar contact on the green. That's how it looks from, yeah, 3D bird's eye view. Is there, is there any contact? I'll check. Ah, no. Yeah, we're very, very close here. Just, just touching. Yep, no differences. And what's the osteotomy like on the green to purple? Ah, green to purple. Yeah, it's now just in contact. Okay, is it slightly in contact? It's slightly in contact. Yeah, okay, just put the thing on the condyle again and just actually rotate it. Inwards? Outwards. Outwards. This is half a degree outwards. Is it touching now? Sure, you can see it. Yeah, quarter of a degree more. This is quarter of a degree more. A bit more? Yeah. That's it, you got it, you got it, you got it, you got it. Yeah, that's good. All right, just check your distances. Oh, look at how symmetrical that is. Yeah, this one is now, yeah, it's actually... Yeah, look, that's spot on. Yeah. Isn't that, that's cool. All right, okay, all right, okay. So we've got it spot on now, right? Yes. And we've got a really good bite. Just show me, because there's... Yeah, no, that's, that's really good. You there? Yes. Oh, yeah. Do you see how I'm getting it symmetrical, but you see how the teeth aren't contacting on the right? Zoom in on there, love. Oh, yeah, so I was just quickly saving once again, and then I'll zoom. Zoom in on the right side, at the molars, or? At the green molars. Yeah, just give me seconds. You see, see how they're out of contact in the mid-eye? Yeah. And just show from the left, and it's only ever so slightly out of contact there, but, but the thing is now that the Invisalign can shuffle those teeth. Does that make sense? Yeah. The ones on the right that are not connected, we can try to get them to connect with Invisalign. Yeah, that's right, but what I want to do is, I want to get a bit of a deeper overbite. Can you put a rotation point on both green and yellow now? Yeah, at the, at the sagittal? Yeah, yeah, right in the middle, yeah. And I want you to drop the sagittal back one degree. I guess, just, yeah. One degree? Yeah. And I want you to lift everything up half a mole, and give me a deeper overbite. That's it. Okay, yeah, all right, that's, that's fine. Okay, and move it from the left. Now, I know I've got a positive contact on that central. Just zoom in on that molar. Is there any contact? I'll just quickly check. Yeah, we're very close. Just close? Definitely here, just over here. It's just close, yeah? Yeah. Let's look at the central, the insides as well. At the patient's left side? Right side. All right, so we're touching at the central. Just touching? Yeah. Okay, we're just touching. Very, very slight. If I zoom in, it's... Yeah, but it's within the wiggle room of the periodontium. Yeah, it's one. If we get any deeper, you can check. Bracketed, that is line. Just a little from the right, yeah? And that, that mandible occlusion is just perfect. Is that a true right? That, this is a true right, yeah. Yeah, that's, that's, it's very good. So it's just now invisalign to sort of wiggle them all into place. All right, um, what else? Oh, yeah. Oh, yeah. No, let's check, just check the condyles in there. Yeah, I'll compare it with the pre-op. Um, yeah, just from a point of view. Uh, so pre-op, are there, yeah, what is pre-op? Gonna move. Yeah, we're touching. Uh, I'll show you those slices. Yeah, yeah, perfect. It's just, all right, take purple, take, leave it there, leave it there, leave it there. Take purple, posteri, displace it. This is with half a mil. Yeah, yeah. This is with one mil. And down. And down with half a mil. And back with half a mil. And I'll scroll through it again. Uh, so red is pre-op purple. So we have now. All right, just, uh, yeah, it's so far. Yeah, all right. Just show me the 3D. Yeah, 3D. Okay, translate it for, uh, just show it from underneath. Is red the original? Red is original, yeah. I got something to do with, like, the initial point of rotation. Uh, not sure. No, it's okay. Um, all right, just take purple. Is red original? That is original, yeah. But is, is red on bone there? Just zoom in on, just take purple away. I just want to see. Take purple away. Yeah, this is original. Zoom in on, yeah, right. Just, just zoom in on that for me. I just want to see that. Okay, all right, all right. Okay, no, no, leave it. Okay, put purple back. Okay, drop purple. Drop it forward. Inward a bit more. Okay, move it from the right again. Put it a bit more forward. Show me the space. Just, just twist it a bit. Rotate it. Rotate the whole thing. Okay, yep. Just show me the osteotomy. A little bit. So now, yeah, we're moving it inwards. Yeah, moving it inwards. Yep, yep. Okay, just go up to the condyle again. Okay, put the rotation point at the very, no, at the lateral condylar pole there. Over here? Yeah, now actually rotate that out. Outwards, you mean, like the... Yeah, yeah, yeah, counterclockwise. Counterclockwise, yep. This is one degree. Yep, yep. Two degrees. Okay, stop, stop. And just show me the osteotomy now. So now it's just touching there. There, just touching. Just check the condyle again. So now, if I could create a position, just now the new one, and comparing it with... I'm not touching anything. Nope, not touching anymore. Pretty good, aren't I? Yep, thanks. All right, okay. Can you keep going? Yep, all right, thanks. Happy with that? Right position? Yeah, yeah. Yep, and then show the left side. Again, purple. After aligning, we'll have to create... And do it again? Yep, now let's go up to the front again. I barely touched it. Yeah, yeah, yeah. Put the rotation at the tip of the condyle. Over here? Yeah, and just put the calvarium back. And I just want to make sure I've got the proper way. Just look at it from underneath or laterally. All right, yeah, yeah. Just actually rotate that up. This is half a degree. Actually, this is one more. Okay, how much have I... Just go through your axial slices there. Not axial, sagittal. Sagittal once again. This is... I don't really have it right now. Okay, just displace the whole thing backwards a quarter of a mil. This is about a quarter of a mil. Another quarter. This is another quarter. And down a quarter. Okay, go through the slice. Down a quarter. No, no. Yeah, keep going. All right, just go back. Yeah, go back into... Yep, go back into the 3D. Just measly move it towards the middle to her right quarter of a mil. Another quarter. Okay, check sagittal. All right, thank you. And check the osteotomy. All right, okay. That's all right. It's good. It's good. It's good. Okay, just check your distances again for the ampersand. Mm-hmm, right a mil. Okay, just... It's also, of course, a bit dependent where I exactly measure. Yeah, no, it's from the front. How much wiggle room have I got on the green osteotomy? Between the rims and the... Yeah, I haven't got anything, have I? That's it. That's all I can do. All right. Okay, thanks. All right, let's do the chin. So, I'll just put it more or less in there. So, this goes a bit forward like this. Yeah, just a little bit more. Yeah, half a mil more forward. A bit more. Is there any interference? At the moment, there's this here on the top on the left just sliding. Okay, yeah. Just look at it from the front. Just clockwise rotate that. Reach the point of rotation here. And then just in the middle. Yeah, yeah, yeah. I'll just do 1.5 degrees. Yeah, yeah, yeah. And look from underneath. Yeah, still wiggle it forward maybe half a mil. Half a mil more. Any interference? I think we have a bit of interference. Completely anterior to the cream. Oh, no. Up to here. I can see the cursor there. It's around. Oh, it's... A bit of a small rotation. Just put a rotation point at the front and just drop the back. Yeah, it's one degree. Yeah, just so that it's completely in contact. This is 1.2 degrees. Yeah, just do a little bit more. Yeah, this is 1.5 degrees. We still have a minor... Yeah, yeah, yeah. It's a lot. Drop it more. Yeah. Drop it more. More, more, more, more, more, more, more, more, more, more. That's it. Yeah, so no interference anymore now. No? No. So definitely not cream and even a bit more space on yellow because of that small rotation that we did. Yeah, I just want to retreat the chin back a little bit. Yeah, backward. This is backward half a mil. Yeah, a bit more. Half a mil more. This is half a mil more. And just come up. And just come up. I'll go by steps of 0.1, 0.2, 0.3. Okay, done. All right, cool. Excellent. Excellent. Very happy with that. All right. So just put the underside, hide the calvarium and just compare the jawline. Yeah, we'll do it in a sec once it's safe. Oh, we didn't do the piriform. Oh, no, let's do it. Just put the nose on your case. That's not the nose on your case. Oh, here it is. Okay. Well, to be honest, I think we've over trimmed the septum, over trimmed the base of the septum. Okay. So I don't want to take, I don't want to take away quite some. So definitely on the left with the rim. Yeah. Yeah. I mean, obviously I have to, I have to have something by the cut. Does that make sense? So you want me to like to replicate in, I want to replicate in the model. Does that make sense? Um, not really. Okay, just put the osteotomy plane back up. And instead of having them crossing over there, yeah, it should cross over at the top of the rim. Okay. Yeah. So you just have to adjust all those dots. Yeah. So I'll start with the right sides. Yeah. All the lateral points are fine. Yeah, the lateral points are fine. Okay. And then just all those, these ones are going to need to go higher up. Yeah. Because just what you were doing there, just, just lift all the dots up on the mesial, on the inside. So it's a, it's a, it's a lot more of a U shape. Does that make sense? I'll just start with like pushing everything up immediately. Yeah. Uh, first right side. Otherwise it gives a false impression trimming all that stuff. And I'm not, I'm trying to make that slight so I can push the, the septum into this. Yeah. Yeah, yeah, yeah, yeah. But yeah, yeah. Oh yeah. Yeah. Yeah. Yeah. That's right. Right up. Right up. Right up. So it's pretty cool. It's like a U. Yeah. Yeah. Yeah. Yes. More. Your dad's an e-nose and throat surgeon. Um, and, and just bring the second dot inward, um, laterally as well. Yeah. Well, not quite so much as that, but, but just a little bit more medial again, that second dot. Yeah. Yeah. Yeah. That's it. See if you can replicate yours. That's right. That's fine. That's it. Um, and then I'll, before doing that new one, I'll also just, uh, the left side. Exactly. Like this. Yeah. So happy with that? On both sides? Yeah. Yeah. Okay. That's fine. I'm sorry to interrupt guys. Dr. Thorpe, you mentioned there was a spur on somewhere there. I don't know if it's there. Yeah. Yeah. The spur is just, so all of that's mucosa, that light hand bit, that's your mucosa. So if you hide the mucosa, you'll see the spur. But that's, that's what I'm removing. That's the spur. Oh, okay. Got it. On your right, on our left. And, and I'm just going to shallow that piriform out on that side. So, so the membrane can fold into that and help drag the septum across. Right. And, and then in that groove, I'm going to tie down the base of the septum into the groove. But I obviously can't straighten the top, but I can straighten the bottom and the tube will hopefully push the whole septum across. Because I'm, I'm operating below the tube. I'm not operating above the tube. I can't operate above it because it's in the way. That's okay. We can fix it later as well, right? Yeah. But you have to fix where it slots into first. You can't somehow fix the middle one, not fix where, you know, sitting in. Yeah. Yeah. That's exactly, that's exactly what I want, right? Okay. Perfect. Now it's a, now it's a proper septum. Otherwise it gives the false illusion I could take that all away. Okay. All right. Yeah. Beautiful. Okay. What else am I going to do? Yeah. Oh yeah. Tie the calvarium and look at that. Wow. Wow. How much advancement is on that? Is it 12 millimeters or? Yeah. Just, just what's the advancement? Uh, yeah. So I'll just do the measurements on the sagittal slices, depending on where exactly measured, but here it's on 10.5. I would show you this for me. That's okay. Yeah. That's a, that's a lot. Well, the short side, the one on the right side is what we're really advancing more than the layer, but the midline, I really stretch out all the neck tissue laterally as well as forward. So it's more radial sort of stretching, like you're stretching a hide on a drum and it's, it's very symmetrical. You can, you can see how I've really built out your right side a lot more than that. And what's the distance of the osteotomy on the right? Uh, on the right side it's, you're at the vertical side. Yeah. Um, so inferiorly that's around 8.3. Yeah. So it's just quite a long way. Or no, you measure it from corner to corner. So from purple corner to green. Um, can you repeat that? Oh yeah. Okay. From corner to corner, 11.8 there. That's, it's quite a big distance there. All right. Now there's a step there. Sorry. No, I'm not going to. No, I, I, I, I'm going to use it as a shelf to shove bone into later on to rebuild that. Cause that doesn't grow back. It just doesn't just get a big job. I've got to, we've got to fill that out somewhere. Um, and we talk about that at the time, taking out the plate and on the other side, if you, if you have a look at the other side, it's, it's a much smaller gap because of the asymmetry. That's only, it's only eight. So it's, um, so that side is out, you know, a lot more bone contact to, to heal. That's why we're so fussy trying to get the bone to contact because that's, that's where it's going to and, um, and then later on I have to polyfill it with whatever I can get my hands on, uh, at this stage, bone putty. Um, and, and then looking at the Laforte line, you can see how much advancement we're getting there at the Laforte line. And we've got a little bit, so there's quite a good overlap of bone, but not having any primary contact anywhere. Um, except right at the front, I might just put a bit of extra bone there just to start getting some, some bone healing in tack points, but we'll be leaving that plate in for, for, for a while, just to make sure we get down bone healing. Um, and, but apart from that, you know, I'll talk to you about cheekbones later to enhance it. Um, well that's about it. That's, that's as good as it gets. Okay. So what are we working on? Well, yeah, but the, the, the plate replicates all these moves anyway. So the critical element is getting this design just, just right. Okay. All right. Thanks. Appreciate it. You're welcome. Um, I just have a final question. Um, the date of surgery, I'm sure there's already a fixed date. Have you got a, have you got a date? I do have a date. It's on the 6th of October. Yeah. All right. That's, yeah, sure. Then, um, yeah, we'll start with the design straight away. Yeah. Well, I should have worked that out, but, uh, it's, it's a bit deliberate. Appreciate it. Thank you so much. Yeah. Thank you for doing that. A bit less time than usual. Thank you. Okay. It is, it is complex just because of the precision of the movements, you know, those little degree things, people will think I'm mad, but getting it just right, as close to right as we possibly can. Okay. All right. Sounds good. Yeah. Perfect. Thank you so much. Okay. Thank you. Thank you. Thank you. Have a good night. Yeah. Good day. Thank you.